| NPI | 1578573028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 29669) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: NJ 25MA04387300) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2020-10-22 |